MEDICARE: DR. ROBERT J WHEELER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12043	MO

General Provider Information

NPI Number	:	1669556312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J WHEELER DMD

Provider Business Mailing Address
First Line	:	2665 W CLAY ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2525
Country	:	US
Telephone Number	:	636-916-4448
Fax Number	:	636-946-5188

Provider Business Practice Location Address
First Line	:	2665 WEST CLAY ST
Second Line	:
City	:	ST. CHARLES
State	:	MO
Zip	:	63301-2589
Country	:	US
Telephone Number	:	636-916-4448
Fax Number	:	636-946-5188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/25/2013

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